Hepatitis C Surveillance and Epidemiology in New York City
Angelica Bocour, MPH
Director of Surveillance, Viral Hepatitis Program
Bureau of Communicable Disease
New York City Department of Health and Mental Hygiene
Hepatitis C Surveillance in NYC• High volume of reports
• >200,000 hepatitis C labs• >90% of reports are imported electronically from labs
• Reportable hepatitis C tests: positive antibody, negative and positive RNA, genotype, ALTs reported if on same accession as a reportable lab• Not reportable: negative antibody, positive rapid antibody
• Surveillance Program Goals• Describe the epidemiology of chronic hepatitis C• Estimate prevalence in NYC
• 1.4% (116,000) New Yorkers with chronic hepatitis C (Bocour et al, Epidemiol & Infect, 2018)
• Monitor appropriate diagnostic testing, linkage to care and cure
Demographic Data from Laboratory Reports
Demographic information
received
•Name•Date of birth•Social security number•Sex•Age•Address•Phone number
Do not receive•Race/ethnicity•Country of birth•Risk factors
Acute Hepatitis C
Acute hepatitis C case finding:• Not reliably reported by providers• Without negative antibody test results, cannot identify seroconversions
• Currently identified through dialysis center reports and enhanced surveillance investigations
0
2
4
6
8
10
12
14
16
18
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Num
ber o
f cases
Report Year
Number of reported confirmed acute hepatitis C cases, New York City 2008–2017
People Newly Reported with Chronic Hepatitis C in NYC, 2008–2017
Confirmatory Testing for Chronic Hepatitis C Infection
• In 2017, 11,786 people were reported with a positive antibody test• 9,801 (83.2%) had confirmatory testing• Two‐thirds (66.1%) were antibody positive/RNA negative
• Two‐thirds (65.8%) had a reflex RNA test
• 5,308 were antibody or RNA positive
Antibody positive only,
16.8%
RNA negative, 66.1%
RNA positive, 33.9%
RNA confirmation,
83.2%
5,308people newly reported with chronic hepatitis C infection
Rates of People Newly Reported with Hepatitis C in NYC by Neighborhood*, 2017
*Neighborhood Tabulation Area: https://www1.nyc.gov/site/planning/data‐maps/open‐data/dwnnynta.page
Age Distribution of People Newly Reported with Chronic Hepatitis C in NYC, 2017
0
20
40
60
80
100
120
140
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75 77 79 81 83 85 87 89 91 93 95 97 99
Num
ber o
f peo
ple ne
wly re
ported
FEMALE MALE
Women of Childbearing Age (15‐44 years) Newly Reported with Chronic Hepatitis C
People Ages 0 to 29 Newly Reported with Chronic Hepatitis C, NYC
Characteristics of People Newly Reported with Chronic Hepatitis C, 2017
Enhanced Chronic Hepatitis C Surveillance, July 2009‐October 2012
United States, 50.7%
Unknown, 31.0%
Other, 5.6%
Former Soviet Union,
4.6%
Pakistan, 2.0%
Dominican Republic, 2.0%
Haiti, 1.6% China, 1.3%
Egypt, 1.0%
Latino, 30.7%
Black, non‐Latino, 30.1%
White, non‐Latino, 21.2%
Asian, non‐Latino, 5.6%
Other, 2.3%Unknown, 10.1%
Country of Birth Race/Ethnicity
Hepatitis C Care Cascade for NYC Residents*
*People reported to the NYC Health Department through June 30, 2017 with any hepatitis C test since July 1, 2014‐June 30, 2017**People with a positive antibody and only a negative RNA test are excluded from the first bar
Positive antibody test with no RNA or ever RNA positive**
Positive RNA, ever CuredInitiated treatment
Viral Hepatitis ResourcesHepatitis A, B and C in New York City: 2017 Annual Report
https://www1.nyc.gov/assets/doh/downloads/pdf/cd/hepatitis‐abc‐annual‐report‐2017.pdf
nyc.gov/health/epiquery
Contact information:Angelica Bocour, MPHDirector of Viral Hepatitis SurveillanceBureau of Communicable DiseaseNYC Department of Health and Mental Hygiene42‐09 28th Street, 6th floorLong Island City, NY 11101Phone: 347‐396‐7614Email: [email protected]
